Provider Demographics
NPI:1891883922
Name:CHUAPOCO, ROBERTO DE CASTRO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:DE CASTRO
Last Name:CHUAPOCO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8608 MIRADA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8206
Mailing Address - Country:US
Mailing Address - Phone:702-968-2425
Mailing Address - Fax:702-968-2488
Practice Address - Street 1:3211 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1953
Practice Address - Country:US
Practice Address - Phone:702-968-2425
Practice Address - Fax:702-968-2488
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11482208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506804Medicaid
101628Medicare ID - Type Unspecified
NVH74901Medicare UPIN